GM CSB summary paper 301012 by D7EdGA

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									                       Greater Manchester Clinical Strategy Board

                                Tuesday 30TH October 2012

1.     Introduction

The purpose of this briefing paper is to outline the agenda items considered and key
decisions taken by the GM Clinical Strategy Board at its meeting on Tuesday 2 October
2012.

Attendance:
                 Raj Patel (Chair)             NHS GM
                 Terry Atherton (vice chair)   NHS GM
                 Tim Dalton                    NHS Wigan Borough CCG
                 Jerry Martin                  NHS Bury CCG
                 Chris Duffy                   NHS HMR CCG
                 Lesley Mort                   NHS HMR CCG
                 Jaki Heslop                   NHS North Manchester CCG
                 Mike Eeckelaers               NHS Central Manchester CCG
                 Caroline Kurzeja              NHS South Manchester CCG
                 Ian Wilkinson                 NHS Oldham CCG
                 Hamish Stedman                NHS Salford CCG
                 Annette Johnson               NHS Salford CCG
                 Paul Bishop                   NHS Salford CCG
                 Cath Briggs                   NHS Stockport CCG
                 Nigel Guest                   NHS Trafford CCG
                 Clare Watson                  NHS Tameside & Glossop CCG
                 Kate Ardern                   GM DsPH
                 Jenny Scott                   Specialised Commissioning
                 Warren Heppolette             NHS GM
                 Claire Yarwood                NHS GM
                 Trish Bennett                 NHS GM
                 Leila Williams                NHS GM
                 Anne Talbot                   NHS GM
                 Phil Harris                   NHS GM
                 Helen Stapleton               NHS GM

1.1 Apologies:
                 Stephen Liversedge            NHS Bolton CCG
                 Martin Whiting                NHS North Manchester CCG
                 Simon Wootton                 NHS North Manchester CCG
                 Bill Tamkin                   NHS South Manchester CCG
                 Ash Patel                     NHS Stockport CCG
                 Steve Allinson                NHS Tameside & Glossop CCG
                 Vikram Tanna                  NHS Tameside & Glossop CCG

In attendance:
                 Sue Pitt                      NHS Tameside & Glossop
                 Sue Mundy                     NHS Manchester
                 Janet Ratcliffe               NHS GM
                 Andrea Dayson                 GMCCSN
                 Jonathan Martin               NHS GM
                 Alex Heritage                 NHS GM
                 Naomi Duggan                  NHS GM
                 Nicola Onley                  NHS GM
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1.2 Minutes and action log of the meeting held on 2nd October 2012.

The minutes of the meeting held on 2 October were accepted as an accurate record.

Clinical Strategy Board (CSB) noted the following updates from the meeting held on 2
October 2012.

      1.2.1 Academic Health Science Network Steering Group.
The CSB noted and endorsed Dr Ian Wilkinson as the chair of the Academic Health
Science Network (AHSN) Steering Group.

        1.2.2 GM Cancer Summit – September 2012.
The CSB confirmed the outcomes of the Summit and that commissioners recognised the
need for the collaborative unified commissioning of cancer services and that unified
commissioning would be signed off initially by the CSB and be part of the succession
plan of the Clinical Strategy Board beyond next April.

1.3 Clinical Strategy Board Forward plan

The Clinical Strategy Board noted the forward plan.

1.4 Matters arising

        a. Major Trauma Network – Infrastructure and Investment
The Board received a verbal update on the progress to agree establishment costs for the
major trauma centres and the role of NWAS within the Network. Board was updated on
the process to agree the costs, which has already been considered by Heads of
Commissioning (HoC) and Chief Finance Officers (CFO).

The Clinical Strategy Board:
(i) Noted the recommendation of the CFO’s that the infrastructure costs for the
major trauma centres and 2012/13 NWAS arrangements would be affordable and
drawn from the Safe and Sustainable levy for 2012/13.

(ii) Requested that CCG governing bodies and Boards consider a process paper
outlining the recurrent financial implications prior to consideration by the
December CSB.

(iii) Requested that HoCs and CFOs scrutinise the detail and implications of the
revised paper.

        b. Stroke centralisation – provider letters
Clinical Strategy Board was updated that the letters regarding stroke centralisation as
agreed at the September Board have been sent to providers. The letter to Stockport FT
had additional elements added in by the lead commissioner regarding A&E performance
and was sent as a co-signed letter from Raj Patel and Gaynor Mullins.

        c. Community Budget Health and Social Care – interim report
Clinical Strategy Board was updated on the outcome of the discussion at GP Council
with Steven Pleasant on the community budget interim report. The Council was
supportive of the principles and philosophy of the programme, but wanted clarity on
governance and assessment on outcomes. There was also a consideration of the
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concept of deal flows, but Council was clear that accountabilities and responsibilities
would need to be clearly defined.
2 Commissioning Business

2.1 Ambulance Service Commissioning

The Clinical Strategy Board received a paper updating on developments relating to
ambulance service commissioning and performance since its decision to sustain
collaborative arrangements and confirm NHS Blackpool CCG as the lead commissioner
for the North West.

The paper outlined the development since that meeting of a GM Ambulance Service
Strategic Leads group to facilitate direct contact between GM CCGs, the lead
commissioner and NWAS executive team on issues affecting performance and reform
across Greater Manchester.

The Clinical Strategy Board:
(i) Noted the update.

(ii) Noted the establishment at a GM level with NWAS of the GM Ambulance
Strategic leads Group as directed by the May CSB.

(iii) Supported the further engagement of GM CCGs in the work to develop the
commissioning relationship with NWAS and address the operational issues
through the group.

(iv) Endorsed the proposal that NHS Tameside and Glossop will act as the lead
CCG for NWAS on behalf of the GM CCGs.

2.2 PTS and PTS OOH contract lead

The Clinical Strategy Board endorsed the PTS preferred bidder report for the GM “Lot 5”
at its meeting on 4 September 2012. This endorsement was provided to the NW PTS
Programme Board on 17 September 2012. Following the meeting, outcome letters were
then sent to the successful and unsuccessful bidders, and the Alcatel period began. At
the time of writing, the Alcatel period is still live.

As part of planning for the mobilisation phase, the CSB was asked to validate that T&G
CCG will be the contract lead for the PTS and PTS OOH contracts.

The Clinical Strategy Board:
(i) Endorsed the recommendation that NHS T&G CCG will be the contract lead for
both the PTS and PTS OOH contracts.

2.3 Military and Veteran Health

The Clinical Strategy Board received a paper describing the commissioning
responsibilities of the NHS Commissioning Board and Clinical Commissioning Groups
(CCGs) for military and veteran health (MVH) post April 2013.
It outlined the options which the CCG Chief Officers are considering, for how CCGs can
discharge their commissioning responsibilities post April 2013:

      Commissioning Support Units - CCGs need to consider whether the CSU would
       be best suited to provide the support for the kind of responsibilities and initiatives
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       as described. If so, this would need to be included in the agreement with the
       CSU.
      CCG commission - Each CCG would commission itself for its own CCG footprint,
       linking to the NW Armed Forces Network and Lead Local Area Team.
      Collaborative commissioning - A collaborative commissioning arrangement could
       be explored, with a lead CCG and built in support. Learning taken from the
       existing GM work plan and governance arrangements could be used to inform
       the development of this work.

It was confirmed that North Yorkshire and Humber will be the Lead LAT for MVH for the
NHS CB commissioning responsibilities. As there will be no GM LAT responsibility for
MVH, CCGs are being asked to consider how they wish to take forward their
commissioning responsibilities from 1 April 2013.

The Clinical Strategy Board:
(i) Considered the 3 options presented to Chief Officers to enable CCGs to
discharge their responsibilities as regards commissioning military and veteran
health from April 2013.

(ii) Noted the update and the responsibility of CCGs as regards commissioning of
military and veteran health from April 2013.

(iii) Requested that the CCG Chief Officers support delivery of the military and
veteran health plan by reviewing the options and agreeing a recommended
approach for CSB to endorse.

2. Policy and Strategy

2.1 Service Transformation

The Clinical Strategy Board received a report updating on the progress of the work of
NHS GM Service Transformation Directorate.

The report covers progress on the following work programmes:
- Healthier Together
- Making it Better
- Healthy Futures
- New Deal for Trafford
- Major Trauma
- QIPP

Board noted that most of the work streams have confirmed clinical champions and CCG
leads, but gaps still exist for neurosciences, mental health and children’s work streams.

Board considered a detailed update on GM QIPP, as requested by September Board, on
locality QIPP progress across GM, in its role to understand how GM as an economy can
redesign services on a larger footprint to achieve the level of QIPP savings that CCGs may
not be able to achieve on their own in future years.

It was noted that this report has been considered by Chief Finance Officers and Chief
Officers and was approved.

The Clinical Strategy Board:
(i) Noted the updates from the Service Transformation Directorate.
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(ii) Noted the changes to the Healthier Together Programme work streams as
outlined in paragraph 2.5 of the paper to be:
Urgent & Emergency Care to include Acute Medicine
Primary Care to include Long Term Conditions
Neurosciences to be separated from Long Term Conditions as a separate work stream
A new work stream of Medicine and Frail Elderly to be included
Rehabilitation to be included with Medicine and Frail Elderly
A new work stream for Mental Health to be included

(iii) Noted the request for CCG leads for the 3 outstanding work streams of
neurosciences, mental health and children’s and agreed that all CSB members
would discuss CCG representation within CCGs.

(iv) Noted the report as attached at annexe 1 outlining the outcome of the QIPP
deep dive undertaken by the GM PMO and CCG QIPP leads and updating on the
Network-led QIPP schemes.

(v) Noted the concerns as outlined by the SHA and Board of NHS GM regarding
the sustainability of the current reported financial position and the need to deliver
this recurrently in 2012/13, in order to ensure continued delivery of QIPP by CCGs
in 2013/14 and 2014/15.

(vi) Noted the request that all CCG Boards review QIPP plans at their next CCG
Board meeting and that those CCGs who have been requested to provide an
action plan by Board of NHS GM, do so by the end of November 2012.

3.2 Healthier Together vision

The Clinical Strategy Board considered the GM Healthier Together Clinical Vision
documents summarising the first 3 steps of the Healthier Together Programme. Based
upon robust data, intelligence and a series of clinical congresses and public meetings,
the vision documents set out the future aspirations for Greater Manchester services.
The Board considered 6 of the 8 documents:
      Vision document 1 - A Greater Manchester Vision for Emergency General
       Surgery;
      Vision document 2 - A Greater Manchester Vision for Neurological Conditions;
      Vision document 3 - A Greater Manchester Vision for Children’s Services;
      Vision document 4 - A Greater Manchester Vision for Cardiac Imaging;
      Vision document 5 - A Greater Manchester & Cheshire Vision for Cancer;
      Vision document 6 - A Greater Manchester Vision for Rehabilitation.

The Clinical Strategy Board:
(i) Noted the contents of each of the vision documents as work in progress

(ii) Endorsed each GM Healthier Together vision document on the condition that
       caveats and enhancements as requested in the meeting are made.

(iii) Requested that the individual vision documents are brought together to develop
        the full Healthier Together vision.

(iv) Requested that all CCGs should consider and discuss the documents within
       CCGs to inform the developing vision.


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(v) Reaffirmed support for the principle of the programme to ensure the vision
      describes excellence in service delivery, but that it does so in the context of
      quality, the evidence base and affordability.

3.3 Healthier Together public discussion document and feedback

The Clinical Strategy Board received a paper updating on the progress relating to
communications & engagement in support of the Healthier Together programme.

The paper outlined how the Healthier Together programme team will co-ordinate the
communications and engagement function, which will then be delivered both centrally
and locally.

It was confirmed that conversations with the local population are now officially underway
and this will continue with local communities to understand what’s important to patients
and the public in GM. An ongoing conversation will continue across GM with a range of
local patients, public, groups and the voluntary and community organisations, targeting
specifically those who are deemed hard to reach and do not always have a voice. The
aim is to have open, honest and transparent conversations about the future of health
and care services.

The Clinical Strategy Board:
(i) Noted the progress of the communications and engagement work to begin
public and patient consultations on the Healthier Together programme.

(ii) Noted that the paper updated on the specific public communication work, but
did not outline the wider communications and engagement programme of
Healthier Together and requested a paper to December Board.

3.4 Revised Greater Manchester Guidance on new oral anti-coagulant

The Clinical Strategy Board received a paper updating on the revised GM
guidance for prescribing new oral anticoagulants in light of the NICE technical
appraisal (TA249 Atrial Fibrillation – Dabigatran Etexilate) published 15 March
2012, which was endorsed by GMMMG on 01/08/12.

This issue was considered by Clinical Commissioning Board (CCB) - predecessor to
CSB in February 2012, when Board reaffirmed its support for the project and decision
taken by the Commissioning Programme Board that Warfarin should remain the 1 st line
treatment choice for AF and that new oral anticoagulants (NOACs) should be reserved
for use in high risk patients in accordance with the Greater Manchester algorithm and in
whom Warfarin therapy is contraindicated, not tolerated or for those who cannot achieve
a stable INR within 2-3 range. NOACs should be used in line with GMMMG and Cardiac
and stroke network treatment pathway and recommended that the outcome of the
appeal to NICE on its Final Appraisal Documentation (FAD) published on 1 November
2011 is awaited.

The Clinical Strategy Board:
(i) Reaffirmed the decision of the CCB in February that Warfarin remains
recommended first line treatment for patients with AF.

(ii) Recommended that GPs must have a full and informed discussion with
patients before commencing a NOAC.

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(iii) Recommended that patients taking a NOAC should have a regular follow up
at least annually.

(iv) Recommended that GRASP-AF is re-run every 6 months to review
prescribing trends and monitor anticoagulation.

4.     Performance

4.1 GM Contract Steering Group – October 2012

The Clinical Strategy Board received the report of the October meeting of the GM
Contract Steering Group.
The October meeting was the first Contract Steering Group that was extended and
provider contract leads invited to attend.

     a) GM CQUINs and KPIs

The Board was updated on the progress to develop GM KPIs and CQUINs and provide
any further intelligence from the DH on this.
The previous CSB requested information on the current progress across GM to deliver
the 6 high impact changes as outlined in the Innovation, Health and Wealth report 2011,
along with circulation of the document detailing proposed GM KPIs, CQUINs and
commissioning intentions.

The Clinical Strategy Board:
(i) Endorsed the view of the Contract Steering Group that the date for delivery of
negotiation timetables should be delayed until end of October until clarity can be
agreed with Commissioning Support Unit on the role for 2013/14 contract
negotiation.

(ii) Endorsed the recommendation of the Contract Development Group that the local
surveys/questionnaires that comprise s.12 of contracts that are already in place
should remain local. If a GM survey is required, the Clinical Strategy Board will be
asked to approve what would be required and what should be recovered (on the
advice of the Contract Steering Group).

(iii) Endorsed the recommendation of the Contract Steering Group that the
establishment of “Rules of Engagement” between providers and PCTs/CCGs should
be implemented.

(iv) Noted the progress on the development of 4 potential Greater Manchester
CQUINs themes of:
 - Academic Health Science Network (AHSN)
 - Reduction in avoidable and unavoidable readmission
 - Transfers of Care
 - Reduction in alcohol dependency

(v) Noted that the themes would be further developed by commissioners at the GM
CQUIN workshop to take place on 5 December in conjunction with provider contract
leads and requested that the January Board receives the final recommended
position on GM CQUINs as recommended by the workshop.




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(vi) Noted the limitations to the Transfer of Care as a CQUIN where this would
impact on social care and all were asked to consider how this could be addressed
locally.

4.2 Specialised commissioning update

The Clinical Strategy Board received an update from Specialised Commissioning on the
Major Trauma Centre accreditation and assurance process, the lead for which has been
handed over from NHS NW to specialised commissioning. The Board requested
assurance that GM CCGs would be able to influence the accreditation process of the
GM Centre and it was confirmed that the Local Area team Directors would be meeting to
agree how this process could be progressed engaging all stakeholders.

The Clinical Strategy Board:
(i) Noted the need for CCG representatives to sit on the Specialised
Commissioning Operational Group (SCOG), but were advised to await clarification
of the Local Area Team specialised commissioning arrangements and revisit this
requirement when this has been clarified.

5. REPORTS

5.1 NW Specialised Commissioning Operating Group agenda and papers

The Clinical Strategy Board:
(i) Noted the contents of the papers.

5.2 Lead commissioner – Month 5

The Clinical Strategy Board noted that this would be distributed to CCGs following the
November Contract Steering Group.

5.3 NHS 111 Programme Board minutes.

The Clinical Strategy Board noted the minutes of the meeting, but also noted that there
had been subsequent meetings of the Programme Board.
Board requested the current minutes to be presented to next Board.

6. AOB

6.1 Ketogenic diet in the management of childhood epilepsy.

The Clinical Strategy Board noted an issue raised by Dr Ian Wilkinson in the context of
an EUR decision taken by Oldham CCG.
Board considered how matters ought to be communicated between the CCGs and the
CSB going forward.
The Chair reminded members of the EUR function that has been developed within the
CSU.

7. Date and Time of Next Meeting

Tuesday 4th December 2012, 9am-12.30pm, St James House, Salford




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